Analysis Of Disdiagnosis Of Tuberculosis Otitis Media (with Two Cases Report)

Objective:1,To analyze the causes of misdiagnosis of TOM.2,To deepen understanding and vigilance of TOM, so as to reduce its misdiagnose and complications.Methods:Retrospective analysis of two cases of TOM which were misdiagnosised,we analysis their clinical manifestations, laboratory findings, imaging findings, treatment, follow-up cases and the causes of misdiagnosis, in addition we review the literatures.Results:2 patients were cured after the teament of radical mastoidectomy combined with one-year anti-TB treatment, the symptoms disappeared and epithelization had formed completely.Conclusion:the recent clinical manifestations of "TOM" is atypical and the case is uncommom.So it can be difficult to diagnose because it can be easily confused with other acute or chronic otitis media. Compounding this problem is the fact that physicians are generally unfamiliar with the features of TOM. Finally, the final diagnosis can be difficult because it requires special culture and pathologic studies. Patients are required to alert in the following conditions:1, short course, no obvious predisposing factors; 2,long-term antibiotic treatment is ineffective, easily relapse; 3, the granulation is pale; 4, those who have early severe hearing loss even with sensorineural hearing loss; 5, temporal bone CT prompted severe bone destruction, especially those who appear sequestrum; 6. the history or previous history of TB or TB contact, especially infants and young children who are not vaccinated.7. The early occurrence of facial paralysis;Those cases shall be progressed promptly line pus culture of M. tuberculosis,PCR,PPD,chest radiography,TbA,granulation biopsy further to exclude the diagnosis of TOM. After the diagnosis the treatments include systemic and local application of anti-TB therapy, surgical treatment and supportive care. For the cases with active pulmonary tuberculosis,early and effective anti-TB treatment can prevent severe hearing loss and other complications. For the cases whose anti-tuberculosis treatment fails, or which are associated with middle ear cholesteatoma, poor drainage or intracranial complications, surgical treatment should be prompt, combined with the anti-tuberculosis treatment.